Intracranial Hemorrhage After Trauma: A Family's Concerns

Intracranial hemorrhage

Dear Doctor, my mother-in-law has sustained multiple fractures and intracranial hemorrhage due to a car accident.
We have differing opinions regarding her intracranial hemorrhage status:
1.
On the first day, when the patient was admitted to the emergency room, a CT scan of the brain was performed, which showed intracranial hemorrhage, but it was not severe and required further observation.
However, I noticed blood-tinged fluid coming from her ear, which made me feel uneasy.

2.
On the morning of the second day, the patient was awake and could call out the names of visitors, but she did not know where she was and did not understand why she had multiple bandages on her body.
She seemed disoriented, as if in a dream, and spent most of the day in a stupor, with small amounts of dark or fresh blood occasionally leaking from her ear.

3.
On the morning of the third day, the patient underwent surgery to repair three fractures.
By 1 PM, she was returned to the ward, but since then, she has been in a deep sleep and cannot be awakened.
However, she does respond to external stimuli by brushing away hands that touch her body.
After the surgery, she has been receiving IV fluids and pain medication (0.5 mg/hour).

4.
On the fourth day, the patient remains in a state of deep sleep.
I requested the doctor to perform another CT scan to confirm the status of the intracranial hemorrhage, but the doctor deemed it unnecessary and stated that observation was sufficient (as the patient has not exhibited symptoms such as vomiting, constricted pupils, or eye deviation).
I feel deeply anxious but do not know what to do.
Please advise.
Thank you very much.

Ronnie Lou, 40~49 year old female. Ask Date: 2002/06/25

Dr. Wu Jingtang reply Breast and Thyroid

Regarding the aforementioned state of drowsiness, it is unclear whether there is a lack of awareness (such as being unable to recognize a finger count of 12) or if it is simply drowsiness that requires further understanding.
However, the majority of the indications for a CT scan are related to deteriorating consciousness, decreased Glasgow Coma Scale scores, and pupillary dilation, primarily to assess the need for surgical intervention.
Therefore, the descriptions provided should be further observed.

Reply Date: 2002/06/25

More Info

Understanding intracranial hemorrhage (ICH) following trauma can be a source of significant anxiety for families, especially when the affected individual exhibits concerning symptoms. Your concerns regarding your mother-in-law's condition after her car accident are valid and warrant careful consideration.

Intracranial hemorrhage refers to bleeding within the skull, which can occur due to trauma, such as in a car accident. The severity of ICH can vary widely, and its implications depend on various factors, including the location and volume of the bleed, the patient's age, and any pre-existing medical conditions. In your mother-in-law's case, the initial CT scan indicated that the bleeding was not severe, which is a positive sign. However, the presence of blood or fluid leaking from the ear can be concerning, as it may indicate a possible skull fracture or a breach in the protective layers surrounding the brain.

The symptoms you describe—confusion about her surroundings, inability to recognize familiar faces, and excessive sleepiness—are not uncommon in patients with ICH. These symptoms can be attributed to the brain's response to injury and swelling, which can affect cognitive function and consciousness. The fact that she is responsive to pain stimuli is a good sign, indicating that she is not in a deep coma, but her overall state of confusion and lethargy is concerning.

Regarding the decision not to perform another CT scan, this is often based on clinical judgment. Physicians may choose to monitor the patient closely if there are no acute changes in neurological status, such as worsening headache, vomiting, or changes in pupil size. However, your anxiety is understandable, especially given the evolving nature of her symptoms. If you feel that her condition is deteriorating or if new symptoms arise, it is crucial to communicate this to her medical team. Do not hesitate to advocate for further imaging if you believe it is necessary.

In terms of recovery, the brain can take time to heal after trauma, and the process can be unpredictable. Some patients may experience gradual improvement, while others may have lingering effects. Rehabilitation, including physical, occupational, and speech therapy, may be beneficial as she begins to recover. Engaging with her healthcare team about a comprehensive rehabilitation plan can help address any cognitive or physical deficits she may experience.

It is also essential to consider the emotional and psychological aspects of recovery. Patients who have experienced significant trauma may exhibit changes in mood or behavior, which can be distressing for both the patient and their family. Support from mental health professionals may be beneficial in these cases.

In summary, your concerns about your mother-in-law's condition are valid, and it is essential to maintain open communication with her healthcare providers. If you feel that her symptoms are not improving or are worsening, do not hesitate to seek further evaluation. Recovery from intracranial hemorrhage can be a long process, and having a supportive family and a proactive medical team can make a significant difference in her healing journey.

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